This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Tuesday, 10 May 2011

Regarding Unions:

This post is going to be about those fucked up, leftist, evil, worthless extortion machines unions.

I hate them. In the late 19th and early 20th century they were necessary. They brought into being good policies that are now enshrined in law. Now they just exist to make themselves money and scoff at people who actually take on responsibility and work for a living.

I recently read a comment on this blog that concerned me. I am afraid that the author of the comment saw the word "militant" in the title of this blog and mistook me for some pro union communist bitch. He didn't say that but that is what people think of Nurses isn' it. So lets clear things up. We may have to be hard bitches to stop people from getting hurt and dying in hospital but I think most nurses realise that unions are nothing but a really, really bad joke.

This is the quick, quick version of Nurse Anne's take on unions:

Please do not see the word militant in the title of this blog and think that we are pro-union.

Frontline clinical hospital nurses understand better than ANYONE that unions are worthless, evil extortion machines that care nothing for the people that they are supposed to represent.

Most Nurses are in the RCN for the liability insurance they provide. We need this to practice.

It would be very easy for any hospital nurse to get distracted by one of her 15 patients and their relatives long enough to make a fatal error. Long enough for this to happen is two minutes. That is the sole reason the RCN got my money. If that happened to me they would help me with the legal stuff. Supposedly.

Unions show no interest in and can do nothing about the short staffing, poor skill mix, shit working conditions, and unsafe patient care. They know they can't do a thing about it. They are only interested in making money for themselves.

When I, at 26 weeks pregnant, was left as the only RN on a 21 bed ward for 14.5 hours unable to eat, drink, sit down or pee during all that time without risking a manslaughter charge the RCN did not want to hear about it. The RCN rep told me that I should have "left the patients and gone for a lie down if it was so bad". Those were my days as an NHS Staff Nurse.

The other staff I had working with me that day were untrained care assistants and they could not help me with drugs, orders, assessments, monitoring and information management for all those patients. They were parked at the Nurse's station having a natter. You can see how it looks to the patients and visitors. On that day there were so many patients on IV drugs that it took me 50 minutes out of every hour to just mix and prepare, and administer the damn things. That includes all the time I had to spend chasing pharmacy to get the fucking things. And on average I was getting them to the patients about 3 hours late. That is because there were so many other things going on simultaneously to those drugs that on an RN could handle. And I was the only RN.

The care assistants cannot help me with that, nor can they give information about the patient's care to relatives who were queing up at the nurse's station to get information------wondering why all the "nurses" were sat at the desk ignoring them whilst mum's IV meds were late.

Had the NHS hired all those new grad nurses that they trained; days like that never would have happened to me. I would have had other trained nurses working with me. You all bitch about new nurse training causing standards to slip. Standards have actually slipped because trained nurses have been replaced on the wards with people who have never attended nursing school. The one RN on duty gets overwhelmed and things get delayed. Mistakes get made. One hundred hardworking, good care assistants working with the RN cannot prevent that. That is why standards are slipping.

What I am militant about on militant medical nurse is that fact that unions are bastard extortion machines that make it easy for management to starve the frontlines (especially nursing) of resources and funding. Unions care about unions. The end.

Please do not believe this bullshit that goes around about NHS nurses having an easy time of it compared to the private sector because they are unionsed public servants.

The RCN got my money every fucking month because I need liability insurance. I know that they won't do shit about working conditions and patient safety.

I am now abroad. My new hospital is non unionised. The folks that run my new hospital have won awards for treating their nursing staff so well. These people understand that when RN's have manageable patient loads, are well resourced, respected, and supported, our patients get better care. It is cash well invested and makes the hospital money that gets put back into even better care for the patients. We are non profit but not government. It is a good cycle.

All those expensive unions in the UK have never, ever made an attempt to get NHS managers and UK politicians to understand this. Unions are just extortion machines that are interested in making money for themselves. The doctors have the same problems with their union in the UK. Even if these unions gave a shit, they would still be powerless to change anything at this point, unless they were completely restructured. Maybe if NHS nurses had decent unions who were simply about protecting the worker things would be okay. But they are far from okay.

So I am non unionised now and can buy my own malpractice insurance. I am so happy these days I weep for joy. I now love my work. I am so happy to be back in the private sector that I cannot stop smiling. Yes I am non unionsed, and if I make a mistake my new employer can fire me at will. So what? If I fuck up that badly with only 4 patients,and much in the way of 24/7 back up and support then I deserve to get the sack. I don't always get a lunch break in a 12 hour shift. But I get them a lot more now than I did when I was a unionised NHS whipping boy sacrificial lamb slave Nurse

Australia: One RN (an RN is a person who has attended Nursing school) to 4 patients on a general medical ward. 24/7 Pharmacy, clerks, and housekeeping support the RN making it easier for her to get her patients what they need.

USA: One RN to 4-7 patients on a 30 bed general medical ward. 24/7 Pharmacy, clerks, and housekeeping support the RN making it easier for her to get her patients what they need.

Singapore: One RN to 4-7 patients on a 30 bed general medical ward. 24/7 Pharmacy, clerks, and housekeeping support the RN making it easier for her to get her patients what they need. This is what singamore nurses tell me anyway. I've never been there.

England One RN to 12, 15 or 30 patients on a 30-ish bed medical ward. She might have several untrained carers that assist with basic care only. Pharmacy, clerks, and housekeeping are 9-5 and dump on the RN. If the RN doesn't do their bidding, the patient doesn't get what he needs and the Nurse gets the blame. The RCN is oblivious.

And I think the UK is more heavily unionised. What does that tell you?

29 comments:

Oh yeahhhh baby she's back! Funny enough I was going to write a blog this evening about the Unions (or the one you mentioned here) but held off. I'm glad you have covered them.

I'm so glad you're back Anne, and that you're happy now in the new hospital. When I move out to the US (which is becoming more and more likely with the boyfriend) in a few years, I'll be asking you where I can get some work ;). I bet it's a real weight lifted off your shoulders being home and out of the NHS, back in a safer work environment. When can we be seeing more and more ruthless posts about your time in the NHS? I wanna read the dark stuff.

I'm glad you're out of that hellhole. Sorry you had to go abroad to manage it. I have much happier memories of the NHS -- but when I studied Midwifery at Cambridge it was probably before you were born [1974-75] and even then, I knew I saw the NHS at its best; Cambridge was not average.

Thanks for the link! I agree with a lot of what you say and I will reply on madosphere later.

Nurses may not be as unionised here but we have some very powerfully organised nursing associations that lobby the shit out of congress and get things like the safe staffing act passed. Technically speaking they are not unions.

So when they push for stuff you don't get the american equivalent of daily mail readers making assumptions about "unionised nurses" who "already have it easy" "getting even more perks".

Instead we have non union nursing organisations educating people and government. It just isn't done through threats.Be careful when saying that MMN is a ron paul libertarian on your blog. I am one,of course, but I doubt your readers would understand the difference between rich oil baron republicans, american libertarians and british libertarians. I think that british libertarians tend to be wealthy. Over here, being a ron paul libertarian is very much a salt of the earth working class affiliation. I doubt your readers would get that.

I'm a nurse in Victoria, Australia, where we're currently fighting to keep an all-nurse workforce in the public acute system and defending our hard-won ratios.

I found your blog while searching for information about the effects of nursing shortfalls to post on the campaign's Facebook site (https://www.facebook.com/RespectOurWork#!/RespectOurWork).

"The Stupid Things They Say" was brilliant, and I've read many of your other posts in one sitting; during "Things I Would Love to Tell Patients and Families" I was torn between laughing and crying out of recognition - and that's despite contributing to the AN thread. It's so true that what binds us is greater than the differences between us, regardless of where we nurse.

So I was a little disappointed when I read this post. I certainly appreciate that the RCN is a rather significant failure as a union - I've heard very little about anything useful they've done for clinical nurses.

However, that's certainly not been my experience with our union, the Australian Nursing Federation - the ratios we achieved in 2000 (the first legally mandated ratios in the world) were won wholly because of the union, who have successfully defended them against government attack in 2001, 2004, 2007 and we're currently three months in to the latest damn battle.

NSW fought for and won ratios last year, but none of the other states or territories have them yet, so your summary of Australian conditions isn't quite accurate. Conditions are certainly a magnitude better here than in the UK - wholly and solely because of the activities on the union and its members.

We can see from current Victorian government proposals what would happen in the absence of a strong union - not only do they want to replace some 1,850 nurses with minimally trained staff, they also want to introduce unlimited short shifts (as short as 4 hours) and split shifts, with an unpaid break of an hour or two in the middle of the day.

75% of Victorian nurses are members of the Federation, which is a professional body as well as a union. Without it we'd be in the smae position as the NHS.

Our RCN-equivalent, the ROyal College of Nursing Australia, is politically apathetic, academically-oriented, and reflects the reality of a tiny percentage of the nursing population. The division between academic interests and industrial defence has served us well - the UK nursing workforce needs to do something similar before it's subsumed.

The RCN is a crap union. They pride themselves on being non-militant and as a result completely fail to stick up for their members, their patients and the NHS, and as a result are as much to blame for nurses leaving the profession and the decline in the health service as anyone else.

On the other hand, in Australia, the ANF is much more active. I work in Melbourne, Victoria and we've just fought and WON a protracted industrial dispute against the State government. We've kept our 1:4 ratios (that we got originally through union action), we've kept unqualified staff off the wards in acute hospitals, we've said NO to short shifts and split shifts, and we've got pay increases of 14-21% and all because of UNION activism and collective action.

So slag off the RCN by all means, but don't slag off unionism, it's what's kept me in nursing.

He isn't a white supremicist. He is an obstetrician who got all of his patients seen to regardless of ability to pay WITHOUT being under the government's thumb. He is also the only person running for US president who A. Understands how the economy works, B. understands the US constitution and C. wants US troops OUT of other countries effective immediately and forever.

e. There are more than most likely other travel nurses out there, operating or living in an area close by. Racist remarks such as, "I do not want you to take care of me because you are not good and are not from my race" or "I do not like working with her because of her skin color" still happens in the present time. Nursing jobs offer not only good pay, but also flexible schedules. Certified Nursing Assistant Salary Durham Nc

Awesome website you have here but I was wanting to know if you knew of any forums that cover the same topics talked about in this article? I'd really like to be a part of group where I can get feed-back from other knowledgeable people that share the same interest. If you have any suggestions, please let me know. Thanks a lot!

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.